Abstract

Keywords

Summary

In a group of patients from 5% to 10%, although the biliary flow was reestablished after ERS,
the biliary pathology persists manifested through the clinical picture of transitory mechanical
jaundice, chronic cholangitis and primary choledocholytiasis. Reinstallation of the biliary pathology
is caused by the development of duodenobiliary reflux, on the background of duodenostasis and
insufficiency of papilla Vater.

This research was carried out for a period of 12 years (1992-2004), including a number of
47 patients, who have been treated at the Nr.2 Surgery Department, Gastrosurgey Unit. All the
patients underwent colecistectomy and afterwards reinterventions on biliary tract including ERS,
CDA with choledocholytotomy.

The diagnostical algorithm included: biochemical tests, US, ERCP, duodenography,
biliscintigraphy, manommetry, MRI and morfological invetigation of the choledoch. The
paraclinical investigations demonstrated the presence of duodenostasis and duodenal malrotation,
duodenobiliary reflux, CBD over 2 cm with primary stones with a good permiabiliy of the papila of
Oddi and with organic changes occurring on the choledochal wall, these including muscular
dystrophy, degeneration of nervous fibers and installation of choledochal diffused fibrosis. The
dilated CBD functionally atonic was named by us secondary megacholedoch.

Until 1998 the surgical treatment in 15 patients included biliodigestiv anastamosis (CDA and
choledochojejunoanastamosis). The results were unsatisfactory because more than in 50% the
clinical signs persisted, caused by the mentainance of the duodenobiliary reflux. This considerations
allowed us to propose and implement a new operational technique which excludes the
duodenobiliary reflux, consisting in supraduodenal excision of CBD with its implantation in Y loop
à la Roux. This tactic of treatment allowed the recovery of the patients with socioprofessional
reintegration in 96,77%.